A4259 HCPCS code: Lancets, per box of 100
A4259 is the HCPCS Level II code for lancets, per box of 100. The 2026 Medicare DMEPOS fee schedule pays $1.42 depending on the state. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 1 per day on DME suppliers. Medicare volume fell 39% from 2022 to 2024 (2,367,962 to 1,443,281 services). In 2024, 38,597 suppliers billed Medicare for A4259 (purchases), serving 570,601 beneficiaries; California, New York, Illinois accounted for 26% of services. Its average fee ranks 2 of 18 A42 codes (family range $0.61–$273.28).
Code details
| Field | Value |
|---|---|
| Section | A codes — Transportation, medical/surgical supplies and miscellaneous |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 34 — DMEPOS: supplies necessary for the effective use of DME |
| BETOS category | D1E — Other durable medical equipment |
| Added | 1985-01-01 |
| Last action effective | 1996-01-01 |
2026 Medicare DMEPOS fee schedule for A4259
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $1.42 | $1.42 | — | — |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $1.42 | — |
| AL | — | $1.42 | — |
| AR | — | $1.42 | — |
| AZ | — | $1.42 | — |
| CA | — | $1.42 | — |
| CO | — | $1.42 | — |
| CT | — | $1.42 | — |
| DC | — | $1.42 | — |
| DE | — | $1.42 | — |
| FL | — | $1.42 | — |
| GA | — | $1.42 | — |
| HI | — | $1.42 | — |
| IA | — | $1.42 | — |
| ID | — | $1.42 | — |
| IL | — | $1.42 | — |
| IN | — | $1.42 | — |
| KS | — | $1.42 | — |
| KY | — | $1.42 | — |
| LA | — | $1.42 | — |
| MA | — | $1.42 | — |
| MD | — | $1.42 | — |
| ME | — | $1.42 | — |
| MI | — | $1.42 | — |
| MN | — | $1.42 | — |
| MO | — | $1.42 | — |
| MS | — | $1.42 | — |
| MT | — | $1.42 | — |
| NC | — | $1.42 | — |
| ND | — | $1.42 | — |
| NE | — | $1.42 | — |
| NH | — | $1.42 | — |
| NJ | — | $1.42 | — |
| NM | — | $1.42 | — |
| NV | — | $1.42 | — |
| NY | — | $1.42 | — |
| OH | — | $1.42 | — |
| OK | — | $1.42 | — |
| OR | — | $1.42 | — |
| PA | — | $1.42 | — |
| PR | — | $1.42 | — |
| RI | — | $1.42 | — |
| SC | — | $1.42 | — |
| SD | — | $1.42 | — |
| TN | — | $1.42 | — |
| TX | — | $1.42 | — |
| UT | — | $1.42 | — |
| VA | — | $1.42 | — |
| VI | — | $1.42 | — |
| VT | — | $1.42 | — |
| WA | — | $1.42 | — |
| WI | — | $1.42 | — |
| WV | — | $1.42 | — |
| WY | — | $1.42 | — |
How the A4259 fee compares
| Measure | Value |
|---|---|
| Rank among 18 A42 codes (lowest = 1) | 2 |
| Family fee range (average of state fees) | $0.61–$273.28 |
| Rural fee uplift | — |
Who bills A4259 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 38,597 |
| Referring clinicians | 165,635 |
| Medicare beneficiaries | 570,601 |
| States with claims | 57 |
| Share of services in top 3 states (California, New York, Illinois) | 26% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 42,068 | 812,338 |
| 2023 | 40,883 | 682,533 |
| 2024 | 38,597 | 570,601 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4259, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 2,367,962 | 812,338 | $1.46 | $1.03 |
| 2023 | 1,890,817 | 682,533 | $1.48 | $1.03 |
| 2024 | 1,443,281 | 570,601 | $1.49 | $1.03 |
States with the most A4259 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 183,285 | $0.95 |
| New York | 98,907 | $1.05 |
| Illinois | 90,937 | $1.01 |
| Florida | 78,955 | $1.09 |
| Texas | 72,111 | $1.07 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 1 | Nature of Equipment |
Medicare policy articles for this code
- A52464: Glucose Monitor - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (461 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| E08.00 | Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) | 1 |
| E08.01 | Diabetes mellitus due to underlying condition with hyperosmolarity with coma | 1 |
| E08.10 | Diabetes mellitus due to underlying condition with ketoacidosis without coma | 1 |
| E08.11 | Diabetes mellitus due to underlying condition with ketoacidosis with coma | 1 |
| E08.21 | Diabetes mellitus due to underlying condition with diabetic nephropathy | 1 |
| E08.22 | Diabetes mellitus due to underlying condition with diabetic chronic kidney disease | 1 |
| E08.29 | Diabetes mellitus due to underlying condition with other diabetic kidney complication | 1 |
| E08.311 | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema | 1 |
| E08.319 | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema | 1 |
| E08.3211 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye | 1 |
Showing 10 of 461. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for A4259
- 1985-01-01: A4259 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code A4259?
A4259 is the HCPCS Level II code for lancets, per box of 100. Short descriptor: "Lancets per box".
How much does Medicare pay for A4259?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $1.42. Rural fees can be higher.
Does Medicare cover A4259?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for A4259?
Medicare policy articles that cite A4259 list 461 covered ICD-10-CM diagnosis codes across 1 article. The most cited include E08.00 (Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)), E08.01 (Diabetes mellitus due to underlying condition with hyperosmolarity with coma), E08.10 (Diabetes mellitus due to underlying condition with ketoacidosis without coma). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
Did the Medicare fee for A4259 change in 2026?
The average non-rural state fee moved from $1.42 in 2025 to $1.42 in 2026 (+0.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A4259 can be billed per day?
1 on DME suppliers (NCCI medically unlikely edits).
Related A42 codes
- A4206 — Syringe with needle, sterile, 1 cc or less, each
- A4207 — Syringe with needle, sterile 2 cc, each
- A4208 — Syringe with needle, sterile 3 cc, each
- A4209 — Syringe with needle, sterile 5 cc or greater, each
- A4210 — Needle-free injection device, each
- A4211 — Supplies for self-administered injections
- A4212 — Non-coring needle or stylet with or without catheter
- A4213 — Syringe, sterile, 20 cc or greater, each
- A4215 — Needle, sterile, any size, each
- A4216 — Sterile water, saline and/or dextrose, diluent/flush, 10 ml ($0.53–$0.99)
- A4217 — Sterile water/saline, 500 ml ($2.18–$4.93)
- A4218 — Sterile saline or water, metered dose dispenser, 10 ml
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under A4259
- Watch A4259 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4259
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule 2026; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.